Compounding pharmacies.

[Slosh]

Hi - can anyone recommend a compounding pharmacy in UK.

Have had such a bad reaction to new 50mcg (Accord). Don’t have in Teva - which I also react to but less.

[SlowDragon Administrator]

Are you lactose intolerant

Try Aristo - Lactose free but 100mcg only

You could cut in half to get 50mcg

GP would need to write new prescription

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems.

Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, or Aristo (100mcg only) are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord only make 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

[Slosh in reply to SlowDragon]

Thank you for this very comprehensive answer. So informative.

It’s actually the 50mcg Accord that I had such a reaction to.

I do react to Teva but more mildly.

I read on a Mast Cell Activation page that the NHS can prescribe Thyroxine that only has tapioca as a filler. Do you know perhaps anything about that?

[SlowDragon Administrator in reply to Slosh]

List of brands and ingredients here

thyroiduk.org/if-you-are-hy...

Liquid levothyroxine can be prescribed via endocrinologist

[SlowDragon Administrator]

Presumably you have autoimmune thyroid disease?

Have you had coeliac blood test done

Are you on strictly gluten free diet?

Or dairy free?

[Slosh in reply to SlowDragon]

I don’t know really - but I would assume that I do have autoimmune thyroid disease as I have other autoimmune issues.

However hypothyroidism is fairly common in my family and and only one other member has autoimmune thyroid disease.

I have been strictly gluten free.

In fact I can tolerate so little at present - due to the Mast Cell Activation having gone nuts since Covid - that I’m down to about 10 foods. I may very well start eating grains again - have lost too much weight and getting weaker.

I don’t even know if I ever had a problem with wheat / gluten etc. Just did it for gut healing.

[MrTHG]

Just out of curiosity what side effects you getting with Teva? My hair Is straight and using Teva it would make my hair go wavey.

[Slosh in reply to MrTHG]

Actually now that you mention it my hair has also become curly.

[Slosh in reply to MrTHG]

The reactions I get are Mast Cell related. Like blood rushes to my neck and head, full feeling and and goes numb, Tinnitus, ears feel blocked, heart races and is irregular. Blood pressure drops.

[helvella Administrator Thyroid UK]

Although there is nothing wrong with the term "Compounding Pharmacy", it is a rather USA-based term. In the UK we tend to speak of "Specials Pharmacy" (or laboratory). That just might help if you do a search.

[Slosh in reply to helvella]

Oh right - thank you for that. I will use that term to search now. Great advice